WHO head says world is facing TB 'time-bomb'

The head of the World Health Organisation (WHO) today warned that emerging, hard-to-treat strains of tuberculosis could spiral out of control and urged countries to help fight the growing threat.

WHO director-general Margaret Chan told health ministers and senior officials from 27 countries worst-affected by the new drug-resistant strains of TB that they must make dramatic improvements in detecting infections and build stronger health care systems.

“Call it what you may – a time-bomb or a powder keg,” Chan said at the opening of a three-day meeting on drug-resistant TB in Beijing. “Any way you look at it, this is a potentially explosive situation.”

In a spur to action, software magnate Bill Gates’ foundation and the Chinese government announced a $33m (€25m) project to test new ways to diagnose drug-resistant TB, new treatments and better ways to track patients.

TB is caused by germs that spread when a person with active TB coughs, sneezes or speaks. The disease is treatable, but now has evolved into stronger forms: multidrug-resistant TB, which does not respond to two top drugs, and extensively drug-resistant TB, which is virtually untreatable.

Left unchecked, people with drug-resistant TB could potentially spread the disease, creating an epidemic in the highly mobile global economy. Even when detected, people infected have to switch to more potent and expensive medicines, posing a problem for many poorer countries.

Of the more than nine million people around the world who contract tuberculosis every year, about 500,000 get multi-drug resistant TB, and nearly a quarter of them are in China.

It is also a problem in India, where rural health care is often poor and there is little control over the sale of anti-TB drugs; Russia, which faces a shortage of qualified medical staff and drugs; and South Africa, where the disease thrives amid an AIDS epidemic that has weakened the immune systems of people with HIV.

“I urge you to make the right policy decisions with appropriate urgency,” Chan said to the officials. “At a time of economic downturn, the world simply cannot afford to let a threat of this magnitude, complexity and cost spiral out of control.”

Chan said less than 5% of estimated cases of drug-resistant TB were being detected and fewer than 3% were being treated according to WHO standards.

Countries attending the meeting are expected to start drawing up five-year national plans to prevent and control the spread of drug-resistant TB. Many countries have been slow to act, said Medecins Sans Frontieres (MSF), in a statement ahead of the Beijing meeting.

MSF’s Tido von Schoen-Angerer said the slow progress in treating people was striking because many of the at-risk countries have thriving economies. “They have the capacity to act, and need to make this a priority and put people on treatment,” he said.

The Bill & Melinda Gates Foundation chose to fund the TB project in China because, Bill Gates said, the scale of the problem is great and the government has the ability to set an example for the world.

The computer entrepreneur said: “Because of its skill, its scale, its TB burden, its love of innovation, and its political commitment to public health, China is a perfect laboratory for large-scale testing of new tools and delivery techniques to fight TB.”

The project will initially cover 20 million people and then be expanded to 100 million people over five years, Gates said.

TB is usually treated in six months with a $20 (€15) cocktail of four antibiotics, but its drug-resistant form takes up to two years to fight. Chan said the cost of treating drug-resistant TB can be as much as 200 times higher than normal TB.

Detecting drug-resistant TB quickly improves the chances a patient will survive and lowers the risk that the disease mutates further into an even more drug-resistant form of the disease.